Comparative effectiveness of apalutamide-, abiraterone-, and enzalutamide-based doublets in mHSPC.

IF 4.1 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International Pub Date : 2026-09-01 DOI:10.1111/bju.70438

Anikó Katalin Valikovics, Dániel Bacsó, Nadeen Samaien, Isabel Pinto Amorim das Virgens, Mahmoud Obeidat, Gergely Bánfi, Boris Hadaschik, Péter Hegyi, Péter Nyirády, Tibor Szarvas

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引用次数: 0

Abstract

Background and objective: Treatment of metastatic hormone-sensitive prostate cancer (mHSPC) has evolved from androgen-deprivation therapy (ADT) alone to combination therapy with androgen receptor pathway inhibitors. Although apalutamide (APA), abiraterone (ABI), and enzalutamide (ENZA) improve outcomes when added to ADT, direct comparative trials between androgen receptor pathway inhibitor-based doublets are lacking.

Methods: Our systematic search was conducted on 22 September 2025, in PubMed, Embase, and the Cochrane Library databases. Studies including patients with mHSPC treated with APA, ABI, or ENZA plus ADT were eligible if they contained real-world data and reported at least one outcome: overall survival (OS), PSA50, PSA90, PSA ≤0.2 ng/mL, time to castration-resistant prostate cancer, biochemical progression-free survival, grade ≥3 adverse events, or treatment discontinuation (TDC). Pooled hazard ratios (HRs) and odds ratios (ORs) were calculated using inverse variance random-effects models.

Key findings and limitations: In total, 17 retrospective studies comprising 18 626 patients were included. Compared with ABI, APA was associated with improved OS (HR 1.27; 95% confidence interval [CI] 1.09-1.47; P = 0.002), PSA90 (OR 0.70; 95% CI 0.54-0.91; P = 0.019), PSA <0.2 ng/mL (OR 0.49; 95% CI 0.25-0.95; P = 0.039), and castration-resistant prostate cancer (HR 1.40; 95% CI 1.05-1.88; P = 0.023). APA also demonstrated higher PSA90 response rates than ENZA (OR 0.67; 95% CI 0.5-0.9; P = 0.017). TDC due to adverse events was lower with ABI than with APA (OR 0.56; 95% CI 0.37-0.86; P = 0.029), with no significant difference between ENZA and APA (P = 0.10).

Conclusions and clinical implications: In real-world settings, APA-based doublets were associated with more favourable efficacy outcomes with ABI, whereas ABI- and ENZA-based regimens were associated with lower TDC rates. ABI and ENZA demonstrated comparable efficacy and safety profiles, supporting individualized ARPI selection in mHSPC.

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以阿帕鲁胺、阿比特龙和恩杂鲁胺为基础的双药在mHSPC中的比较有效性。

背景和目的：转移性激素敏感前列腺癌（mHSPC）的治疗已经从单独的雄激素剥夺治疗（ADT）发展到与雄激素受体途径抑制剂的联合治疗。虽然阿帕鲁胺（APA）、阿比特龙（ABI）和恩杂鲁胺（ENZA）在加入ADT时改善了结果，但缺乏基于雄激素受体途径抑制剂的双重药物之间的直接比较试验。方法：系统检索于2025年9月22日在PubMed、Embase和Cochrane Library数据库中进行。纳入经APA、ABI或ENZA加ADT治疗的mHSPC患者的研究，如果包含真实世界数据并报告至少一项结果：总生存期（OS）、PSA50、PSA90、PSA≤0.2 ng/mL、发生去癌抵抗性前列腺癌的时间、生化无进展生存期、≥3级不良事件或停药（TDC），则符合条件。采用逆方差随机效应模型计算合并风险比（hr）和优势比（ORs）。主要发现和局限性：共纳入17项回顾性研究，包括18626例患者。与ABI相比，APA与改善OS （HR 1.27； 95%可信区间[CI] 1.09-1.47; P = 0.002）、PSA90 （OR 0.70; 95% CI 0.54-0.91; P = 0.019）、PSA结论和临床意义相关：在现实环境中，基于APA的双重方案与更有利的ABI疗效结果相关，而基于ABI和基于enza的方案与更低的TDC率相关。ABI和ENZA表现出相当的疗效和安全性，支持mHSPC中个性化ARPI选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BJU International 医学-泌尿学与肾脏学

CiteScore

9.10

自引率

4.40%

发文量

262

审稿时长

1 months

期刊介绍： BJUI is one of the most highly respected medical journals in the world, with a truly international range of published papers and appeal. Every issue gives invaluable practical information in the form of original articles, reviews, comments, surgical education articles, and translational science articles in the field of urology. BJUI employs topical sections, and is in full colour, making it easier to browse or search for something specific.